This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Thursday, 26 January 2012

Worry grows as second senior nurse leaves NMC | News | Nursing Times

My god. I hadn't actually realised that the Nursing and Midwifery Council has so few actual Nurses on staff. According to this article, they practically have none. The Nursing and Midwifery council is the organisation in the UK that licenses and regulates RNs. In order to work as an RN we have to by law be registered with these people. And they are expensive.

I always knew that they were brain dead and living in a fantasy world but I just put that down to the fact that they were older Nurses who haven't worked clinically in years.

But the truth is that they are not Nurses at all. There is not one person in that organisation that is able to grasp what a Registered Nurse actually is and neither are they able to grasp the idea of Nurse vs unlicensed assistive personel.

If they haven't worked on a ward as an RN responsible for a large number of critically ill patients, they simply won't be able to comprehend the situation. No one can unless they have done it. It is too complicated. Even RNs who left the wards in the 80s cannot comprehend the situation. At all.

This sure explains a lot about why the NMC is so useless. And it sounds like they are "divided" over the licensing of health care assistants.

If they license the health care assistants, then health care assistants will be counted as "Nurses". Your local trust will use this as a way to decrease the number if Nurses working at the bedside.

They simply change beds and do skills without thinking. It would never occur to a health care assistant to notice that the black tarry stools you are passing whilst on a heparin drip may signify the need to contact a doctor, get a PTT ordered, maybe get the drip held and watch closely.

Doctors, I hope you are getting ready to action your own orders, medicate your own patients, titrate your own drips, drop your own NG tubes, program your patient's IV pumps, watch for a million one possibilities for each patient (everything from pre renal failure to hypoglycemia and changes in LOC), do your own ward admissions and discharge planning, escort patients to tests in case they crash in the lift on the way, mix and administer all the IV antibiotics you order, and chase down pharmacy and fight to get the meds you want your patients to have. The care assistants cannot do this. You will have to do it when the RNs are gone.

Doctors, I really hope you are getting ready to handle all of that as well as your own jobs. See the writing on the wall. The RNs are being whittled away. They are going to license health care assistants so that they can get away with replacing Nurses with cheaper alternatives.

People think that all you need for a nurse is a kind heart and a willingness to clean up shit. You'll have that in the HCAs, but that is all you will have. Those wards will have nothing but health care assistants. Health care assistants cannot and will not get involved with any of the things I have suggested that you get ready to do. You poor bastards are going to have to do the job of a ward RN as well as your own job. There are so many real nurses unemployed right now and desperate to work on the wards, but they are unable to find jobs. This will get worse when health care assistants are licensed.

And once the health care assistants are licensed the Hospitals will legally be able to say "but we have 6 nurses on the ward" when really there are only 6 health care assistants and no Nurse.

Hospital Doctors, if I were you I would hunt down the ward nurses to find out how to program an IV pump, do a drug round, mix iv meds, do trach care, peritoneal dialysis and the quickest route to pharmacy. All these things that you order (and expect to be done instantaneously) are going to have to be done by you when the RN posts are lost. I am sure that the RNs will show you the ropes before they are all made redundant.

29 comments:

Do not forget that something very similar has been going between doctors and the other end of your profession. Souped up nurses are being quasi-licensed as noctors. All the arguments you apply to HCA vs RNs apply to noctors vs doctors; and in both cases the chief driver is management (and government) reducing costs; getting more for less; only we are not: we are getting less for less.

And the people who really loose out are the patients. And that means all of us.

Cripes! Dr No is being dim this morning. He didn't follow this through. If noctors replace doctors, then it won't, as you suggest, be the doctors who have to do what the RNs used to do, it will be the noctors. So it will go full circle, and we will be back to nurses doing what nurses used to do - only on higher salaries.

Nurse Anne - you may well be right (about PAs). It may be that when we get them here, they will come through the noctor/nurse practitioner route, or maybe noctors will just mutate into PAs.

They may not be advertising for noctors much, but there are plenty of them skulking around, clipboards at the ready. Its now possible to go through secondary care (as an OP) and not see a doctor at all.

The lack of job vacancies may well be the result of the 'efficiency savings' - the NHS just isn't hiring. People are being made to act up and/or double up the work they do.

Ironically, at the same time, certain medical areas are unable to fill vacancies they do have. There was a hospital that planned to use army medics to fill middle grade posts, and general practice has seen a decline in applicants, with some practices unable to fill vacancies. Perhaps, like you, junior doctors are deciding the NHS is not for them...

The goons who are running the show should see lack of applicants as a serious indictment of what they are doing, but there is about as much chance of that happening as there is of Dr No taking a holiday on the moon.

I think you're tarring HCAs with a very wide brush. I can't speak for all HCAs, but when I'm working as a HCA I am the eyes and ears of the RNs. I keep things going while they're doing tasks I can't. Using my experience and knowledge I bring things to their attention. I've even advised junior doctors and the odd registrar.

So whilst I do agree that HCAs cannot replace RNs, I feel you're doing a great disservice to decent and conscientious HCAs

If there are 5 other nurses working with me on my 30 bedded ward we can split the RN only tasks and also have time to do basic care.

But when I am one nurse for the entire ward with 5 health care assistants working with me I have to manage the RN only tasks myself. This sucks and stops me from doing basic care, which means I am working blind.

Many moons ago I worked at the London Clinic,where only RNs were employed. Staff / patient ratio was good. Day time 1 RN looked after 4 patients + did ALL nursing care. Night time 1 RN to 8 patients + did ALL nursing care. Patients needing more intensive care nursing 1 RN per patient. Last NHS episode as a locum - 2 RNs (incl.me)for 25h heavily dependent patients - not to mention 3 patients in isolation for diarrhoea. Plus 3 HCA's. You cry at what passes for isolation nursing - a little plastic apron that barely covers anything and a selection of gloves oh and 3 commodes for whole ward.Pts eating breakfast next to smelly commode. The management of course happy hosp.festooned with stern notices on handwashing.Paton backs all round that'll teach those nurses how do deal with pesky bacteria.A poster in the ward sluice grimly asked ' have you washed the commode?' I wanted to scrawl across this - How about some ***ing staff? Meds.were a joke. Every patient needing help to sit up + actually take meds.Behold meds from last round still on the locker, or in the bed, not taken - yet signed off as given.Did I get around to seeing all the patients / even half? NO. There was much more. I came off that ward in tears as no nursing was done. Is this is what passes for nursing now ? The question then is it worth losing your license for? Sorry for rant.Anna

Re NMC I'm only suprised it hasn't been outsourced to India. You have to laugh at their mission statement Protecting the public. Bizzare. Guess one of those big accounting firms with Harvard degrees is respopnsible.Anna

I have enjoyed many of your posts here but I must say that having just finished work as a CSW (Scottish hca) I am almost shaking with rage. Your description and comments about the HCA are not only ignorant but utterly derogatory and rude. I am appalled that a RN could say things like this. Nursing is changing. It evolves with society. The HCA is the person the patient sees 9 out of 10 times. The person they confide in about secret symptoms, concerns, issues. The person who sees them and their symptoms. Often when a patient complains of a symptom we are the ones to theb look in The Drug cardex, notify the RN Of the PRN medicine. Today as a CSW I did all of my "brainless" poo cleaning duties with love and care. Then donned the blue gloves to take blood, take observations, carefully fed the patient on special consistency diet monitoring for signs of aspiration, helped the doctor identify c. Diff in a patient by "brainlessly" cleaning up the poo and noting the colour consistency mucus and distinctive smell taking a specimen instinctively. Also taking a specimen of melena I noticed. Also dipsticked an MSU for signs of infection (blood and proteins btw) after noticing the smell earlier. I don't know about in England but here CSWs are highly trained to do their jobs. Intelligent, intuitive and invaluable. We are trained for these things. We work on the ward in te team and would learn these things anyway (abnormalities/ important symptoms) even without training. I am simply enraged. How dare you. We are valuable members of the team just like you. Shame on you to belittle us. Shame on you.

I have NEVER known of an HCA who does the ALL things that you say you do. The ones I worked with in the North of England would not have known what a drug cardex is, nor would they have thought to test urine.

I want to see wards staffed with RNs. I don't have anything against HCAs personally. I can't do a doctor's job and an HCA cannot do mine.

Look at it this way:

What if you needed life saving neurosurgery and when you arrived in theatre there was no neurosurgeon there. Only Nurses. Those Nurses might be nice people who can do lots of things for you. But still you would be fucked. An operating theatre needs surgeons. And it is no insult to Nurses to say so.

And neither is it an insult to HCAs to say that wards need lots of RNs.

Wards need RNs. RNs are forced to be responsible for too many patients and it stops them from being able to spend time with patients and do direct care. This is a very bad thing.

When RNs have too many drugs to give and too many charts with orders to review they make mistakes. Having lots of wonderful HCAs on duty isn't going to fix that.

Mistakes can be fatal and the Nurses are going to make big ones if they are assigned too many patients because the other staff on the ward are all HCAs.

If I am on a 30 bed ward with 5 other Nurses then each of us Nurses has 6 patients each.

If I am working with 5 HCAs that day instead of 5 Nurses then I am responsible for 30 patients instead of 6.

Keeping track of 30 patients is a nightmare.

And even with good hardworking HCAs on duty I am still going to be overwhelmed. And a situation like that is probably going to cause me to make a huge mistake that could kill someone. I don't like that level of stress.

If you think these posts are about insulting HCAs you have severe reading comprehension problems.

These posts are about getting wards staffed with RNs so that we can retain RNs at the bedside rather than stressing them out to the point that they leave healthcare competely.

If you google Linda Aiken's research into RN staffing you will see that patients have higher survival rates when wards are staffed with a higher number of RNs. A safe number of patients for an RN to keep track of is 5. Maximum.

Take my qualified Nurse co worker away and give me an HCA and now I have to keep track of 10 patients instead of 5. Take my other Nurse coworker away from me and give me an HCA instead and now I have 15 patients to keep track of instead of 5. And so on and so forth.

Fifteen patients for one Nurse is overwhelming and terrifying even if she has great HCAs backing her up.

You want to feel rage and pain and the shakes? Experience being the only RN for a large number of patients. Then we'll talk about suffering and pain.

HCAs are a great addition to RNs but they should not be used instead of RNs.

You also have to keep in mind that my hospital in england staffed their wards like this:

W got one RN and 5 untrained under 18 year old care assistants to 30 acute medical patients. When I started there in 1999 there was 6 RNs and 2 older, trained, and experienced care assistants for a shift.

My trust went with the under 18 year olds precisly because they had no experience and were young and untrained. This meant that they could be paid less than an HCA like yourself. Long ago they got rid of the people like you and gave us fucking acne brats with nintendo ds consoles.

They did this as well as losing qualified nurses to retirement, immigration and hiring freezes.

Anne I do agree with you that we need nurses on staff. We can not staff wards with HCA/CSWs alone. And from reading your blog the staffing levels in England sound terrifying and not representative of what we have in Scotland. I am so thankful for devolved healthcare.

Though I do agree with most of the points in this post, Anne I think the problem some people have with the post is the way you have worded how HCAs are brainless and task orientated.

For non British readers Scotland and England have different NHS systems. CSWs are trained to a higher level by the sounds of things in Scotland also. No mindless rote tasks and we do get respect from most nurses for the work we do.

again anne i totally agree with what you are saying concerning hcas. the one massive difference btween trained nurse and hca is accountability. i know alot of fantastic hardworking hcas but they all they have to do is clean people, feed people. care for people, they do a patients bp and tell the trained it high! thats all they have to do, its then up to us to do something about that, at the same time they want us to help clean mrs so an so. i was an hca for 10years before i did my training and in no way did it prepare me for being a trained nurse. they dont go home worrying thank god i didnt kill anyone today!! accountability is a bitch and they will never understand it unless they did their training too.nurse anne are you outspoken at your workplace or do you keep it for here? i have been outspoken and have been told im being disrespectful, i think im just being honest but i get into trouble. doctors lie. im so glad ive found this blog. theres nothing wrong with me after all its just that im a nurse. if i have go sick again i think the doctor shoudnt put deppression as my reason for sickness i think the doc should just put nurse.

Why are nurses so unappreciative towards health care assistants? They talk about them as if they are dirt under their shoes! How dare a lowly health care assistant try to progress or learn the same skills and theory as a qualified nurse! Fine! Take out all the HCAs and staff the wards with only qualified nurses, then the RNs will have to do all the jobs such as bathing, feeding and bed-making that HCAs currently do -and which nurses were originally intended for in the first place, before they went off to get degrees and some sort of 'quasi-doctors', which we don't actually need as we have the real thing! What a petty, immature, and ultimately, useless 'profession'!

You are nothing but a bully who just likes putting down healthcare assistants! You don't want to see them progress because then, as a scared little bully, you won't have them to shit on all the time! Why don't you stop talking about how great you are and go and do some real, proper nursing work - which is what healthcare assistants are doing! Why on earth do we need a whole workforce of quasi-doctors? The noctors, who like to think that they are as good as doctors, but of course, are not! What do we need them for when we have the real thing!!! Registered nurses in America are referred to as the Registered Nuts because of their arrogant, totally screwed-up attitude and delusions of granduer! I would much rather have a decent healthcare assistant and a REAL doctor looking after me than a totally pointless, jumped-up little bum-washer like you hovering around!!!

Hey, very nice site. I came across this on Google, and I am stoked that I did. I will definitely be coming back here more often. Wish I could add to the conversation and bring a bit more to the table, but am just taking in as much info as I can at the moment. Thanks for sharing.Indian Commode Stool For Elderly

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.